scholarly journals Left atrial geometry in an ovine ischemic mitral regurgitation model: implications for transcatheter mitral valve replacement devices with a left atrial anchoring mechanism

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Akito Imai ◽  
Arash Khamooshian ◽  
Keitaro Okamoto ◽  
Yoshiaki Saito ◽  
Inez J. Wijdh-den Hamer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Atrial ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Device Development ◽  
Transcatheter Mitral Valve Replacement

Abstract Background Transcatheter mitral valve replacement (TMVR) is a challenging, but promising minimally invasive treatment option for patients with mitral valve disease. Depending on the anchoring mechanism, complications such as mitral leaflet or chordal disruption, aortic valve disruption or left ventricular outflow tract obstruction may occur. Supra-annular devices only anchor at the left atrial (LA) level with a low risk of these complications. For development of transcatheter valves based on LA anchoring, animal feasibility studies are required. In this study we sought to describe LA systolic and diastolic geometry in an ovine ischemic mitral regurgitation (IMR) model using magnetic resonance imaging (MRI) and echocardiography in order to facilitate future research focusing on TMVR device development for (I)MR with LA anchoring mechanisms. Methods A group of 10 adult male Dorsett sheep underwent a left lateral thoracotomy. Posterolateral myocardial infarction was created by ligation of the left circumflex coronary artery, the obtuse marginal and diagonal branches. MRI and echocardiography were performed at baseline and 8 weeks after myocardial infarction (MI). Results Six animals survived to 8 weeks follow-up. All animals had grade 2 + or higher IMR 8 weeks post-MI. All LA geometric parameters did not change significantly 8 weeks post-MI compared to baseline. Diastolic and systolic interpapillary muscle distance increased significantly 8 weeks post-MI. Conclusions Systolic and diastolic LA geometry do not change significantly in the presence of grade 2 + or higher IMR 8 weeks post-MI. These findings help facilitate future tailored TMVR device development with LA anchoring mechanisms.

scholarly journals Transcatheter Mitral Valve Replacement and Thrombosis: A Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Guido Ascione ◽  
Paolo Denti
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Anticoagulation Therapy ◽  
Unmet Need ◽  
Left Ventricular ◽  
Current Evidence ◽  
Thrombotic Risk ◽  
Transcatheter Mitral Valve Replacement

Mitral regurgitation is the most prevalent form of moderate or severe valve disease in developed countries. Surgery represents the standard of care for symptomatic patients with severe mitral regurgitation, but up to 50% of patients are denied surgery because of high surgical risk. In this context, different transcatheter options have been developed to address this unmet need. Transcatheter mitral valve replacement (TMVR) is an emergent field representing an alternative option in high complex contexts when transcatheter mitral valve repair is not feasible or suboptimal due to anatomical issues. However, TMVR is burdened by some device-specific issues (device malposition, migration or embolization, left ventricular outflow tract obstruction, hemolysis, thrombosis, stroke). Here we discuss the thrombotic risk of TMVR and current evidence about anticoagulation therapy after TMVR.

Left ventricular remodeling after transcatheter mitral valve replacement with Tendyne

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Fukui ◽  
P Sorajja ◽  
M Goessl ◽  
R Bae ◽  
B Sun ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Ventricular Remodeling ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Reverse Remodeling ◽  
Functional Changes ◽  
Transcatheter Mitral Valve Replacement ◽  
Lv Mass

Abstract Background Data on changes in left atrial (LA) and left ventricular (LV) volumes after transcatheter mitral valve replacement (TMVR) are limited. Purpose This study sought to describe the anatomical and functional changes in left-sided cardiac chambers by computed tomography angiography (CTA) from baseline to 1-month after TMVR with Tendyne prosthesis. Methods We analyzed patients who underwent TMVR with Tendyne prosthesis (Abbott Structural, Menlo Park, CA) between 2015 and 2018. Changes in LV end-diastolic volume (LVEDV), ejection fraction (LVEF), mass (LV mass), LA volume and global longitudinal strain (GLS) were assessed at baseline and at 1-month after TMVR with CTA. Specific Tendyne implant characteristics were identified and correlated with remodeling changes. Results A total of 36 patients (mean age 73±8 years, 78% men, 86% secondary MR) were studied. There were significant decreases in LVEDV (268±68 vs. 240±66ml, p<0.001), LVEF (38±10 vs. 32±11%, p<0.001), LV mass (126±37 vs. 117±32g, p<0.001), LA volume (181±74 vs. 174±70 ml, p=0.027) and GLS (−12.6±5.1 vs. −9.5±4.0%, p<0.001) from baseline to 1-month follow-up. Favorable LVEDV reverse-remodeling occurred in the majority (30 of 36 patients, or 83%). Closer proximity of the Tendyne apical pad to the true apex was predictive of favorable remodeling (pad distance: 25.0±7.7 vs. 33.5±8.8mm, p=0.02 for those with and without favorable remodeling). Conclusions TMVR with Tendyne results in favorable left-sided chamber remodeling in the majority of patients treated, as detected on CTA at 1-month after implantation. CTA identifies the favorable post-TMVR changes, which could be related to specific characteristics of the device implantation. Funding Acknowledgement Type of funding source: None

Surgery for Degenerative Mitral Regurgitation Valve Repair v. Valve Replacement with Chordal Preservation

1994 ◽  
Vol 2 (2) ◽  
pp. 90-94
Author(s):  
Masaharu Shigenobu ◽  
Shunji Sano
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Valve Repair ◽  
Repair Group

This study compares mitral valve repair and mitral valve replacement with chordal preservation for chronic mitral regurgitation due to myxomatous degeneration with special reference to left ventricular function. Twenty-six patients underwent complete preoperative and 2 years later postoperative echocardiography study. Thirteen patients underwent mitral valve replacement associated with preservation of chordae tendineae and papillary muscles, and 13 patients had mitral valve repair. There were no statistically significant differences between the 2 groups for clinical findings, hemodynamic profiles, or left ventricular function compared prior to surgery. After correcting mitral regurgitation, increase in cardiac index was significant for the repair group. Left ventricular end-diastolic volume decreased in both groups. Left ventricular end-systolic volume significantly decreased in the repair group, but remained unchanged in the replacement group. Both ejection fraction and mean left ventricular circumferential fiber shortening velocity (mVcf) decreased in the replacement group, but significantly increased in the repair group 2 years after surgery. These findings suggest valve replacement with chordal preservation shows less improvement in ventricular systolic function late after surgery compared with mitral valve repair.

scholarly journals A Giant Left Atrium due to Rheumatic Mitral Regurgitation, Outcome after Left Atrial Reduction Surgey with Mitral Valve Replacement

2018 ◽  
Vol 14 (1) ◽  
pp. 42-44
Author(s):  
Istiaq Ahmed ◽  
Sorower Hossain ◽  
Ankan Kumar Paul
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Atrium ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Atrial ◽  
Quick Recovery ◽  
Replacement Surgery ◽  
Atrial Size ◽  
Giant Left Atrium

A trans-thoracic echocardiography and chest radiograph of a 26 year old lady diagnosed as rheumatic mitral regurgitation with atrial fibrillation revealed a giant left atrium of 10.9 cm size with symptoms of dyspnoea and palpitation. The patient was treated with left atrial size reduction along with mitral valve replacement surgery and showed an excellent and quick recovery with total disappearance of symptoms and restoration of sinus rhythm only within few days.University Heart Journal Vol. 14, No. 1, Jan 2018; 42-44

scholarly journals Safe Technique of Removal of Left Atrial Thrombus during Mitral Valve Replacement Surgery

2016 ◽  
Vol 31 (1) ◽  
pp. 26-28
Author(s):  
Rampada Sarker ◽  
Manoz Kumar Sarker ◽  
AM Asif Rahim ◽  
Abdul Khaleque Beg
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Cavity ◽  
Safe Procedure ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Ventricular Cavity

Background: Open mitral operation in patients with massive left atrial thrombus still with high mortality due to intra-operative embolism. To prevent this mortality due to intra-operative embolism and to prevent this danger we practiced a surgical technique which includes careful handling of heart and obliteration of left ventricular cavity by bilateral compression.Method: We used this technique in patients of severe mitral stenosis with atrial thrombus during mitral valve replacement. Our technique was to obliterate the left ventricular cavity and thus keep the mitral cusps in a coapted position by placing gauge posterior to left ventricle and a compression over right ventricle by hand of an assistant with a piece of gauze. This obliteration prevented passage of fragments of left atrial thrombus towards collapsed left ventricle.Result: Before practicing this technique, 4 out 9 patients expired due to cerebral embolism . But after implementation of this technique in 17 patients no mortality or morbidity occurred.Conclusion: This technique of removal of left atrial thrombus during mitral valve replacement may be a safe procedure for preventing peroperative embolism.Bangladesh Heart Journal 2016; 31(1) : 26-28

Predictors of Left Ventricular Outflow Tract Obstruction After Transcatheter Mitral Valve Replacement in Severe Mitral Annular Calcification: An Analysis of the Transcatheter Mitral Valve Replacement in Mitral Annular Calcification Global Registry

2021 ◽  
Vol 14 (10) ◽  
Author(s):  
Abdallah El Sabbagh ◽  
Mohammed Al-Hijji ◽  
Dee Dee Wang ◽  
Mackram Eleid ◽  
Marina Urena ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Multidetector Row Computed Tomography ◽  
Mitral Annular Calcification ◽  
Transcatheter Mitral Valve Replacement ◽  
Annular Calcification

Background: Several studies have evaluated preprocedural imaging predictors of left ventricular outflow tract obstruction (LVOTO) after transcatheter mitral valve replacement. The patient cohorts in these studies were heterogeneous and included patients with transcatheter mitral valve replacement in failed bioprostheses, annuloplasty rings, and severe mitral annular calcification (MAC). The goal of this study was to evaluate predictors of LVOTO specific to patients undergoing valve-in-MAC. Methods: This study included patients with severe MAC who underwent valve-in-MAC and had optimal quality preprocedural multidetector row computed tomography scans eligible for retrospective analysis. Baseline demographic, echocardiographic, and procedural data on these patients were collected. multidetector row computed tomography parameters were analyzed for association with LVOTO, defined as increase in mean LVOT gradient by ≥10 mm Hg with accompanying hemodynamic instability. Results: Seventy-one patients with optimal preprocedural computed tomography scans were included in this study (mean age, 72.5±13.5 years), 9 of which developed LVOTO (all female). Baseline mean LVOT area, neo-LVOT area (145.3 versus 270.9 mm 2 ; P =0.006), indexed neo-LVOT area (90.1 versus 157.4; P =0.05), and virtual transcatheter heart valve to septum distance (3.1 versus 6.9 mm; P =0.002) were lower in the LVOTO group. Expected % LVOT area reduction was higher in the latter group (58.3 versus 42.7%; P =0.008). In the univariable analysis, the baseline mean LVOT area, neo-LVOT area, indexed neo-LVOT area, and valve to septum distance were all significantly associated with LVOTO. Conclusions: The systolic mean LVOT area, neo-LVOT area, indexed neo-LVOT, expected percentage LVOT area reduction, and the valve to septum distance were associated with LVOTO after valve-in-MAC.

scholarly journals A tensed Tendyne

2020 ◽  
Vol 58 (3) ◽  
pp. 651-653 ◽  
Author(s):  
Daniel Grinberg ◽  
Matteo Pozzi ◽  
Chloé Bernard ◽  
Jean-Francois Obadia
Keyword(s):  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Paravalvular Leak ◽  
Main Challenge ◽  
Low Profile ◽  
Transcatheter Mitral Valve Replacement ◽  
Left Ventricular Outflow

Abstract We report a case of prosthesis dislodgement after transcatheter mitral valve replacement in an 85-year-old woman with chronic ischaemic heart failure. Two weeks after an initial successful implantation, she presented with a paravalvular leak associated with left ventricular outflow tract obstruction. Tether re-tensioning was performed and resolved the situation, but resulted in a deformation of the apical attachment zone into the left ventricle. Unfortunately, the patient finally expired from severe endocarditis. Proper anchoring is the main challenge for transcatheter mitral valve replacement techniques. Dislodgement of the prosthesis after transcatheter mitral valve replacement is an infrequent complication of the Tendyne® procedure. This case emphasizes the importance of assessing the quality of the myocardium at the implantation zone of the apical pad, and of prosthesis oversizing, especially if low-profile valves are chosen. .

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